{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T18:09:12Z","timestamp":1791655752001,"version":"4.3.4"},"reference-count":188,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:00:00Z","timestamp":1784160000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Kienb\u00f6ck disease, osteonecrosis of the lunate of uncertain aetiology, presents with progressive pain, stiffness, and grip loss in dominant-hand-using adults during their most productive working years, yet its rehabilitation literature has lagged behind its surgical counterpart. This narrative review synthesises current rehabilitation evidence across conservative and post-operative pathways, mapping recommendations to disease stage and to surgical procedure. Following SANRA-aligned methods with selected PRISMA 2020 transparency elements, we appraise immobilisation and orthotic management, dart-throwing-motion-plane mobilisation, sensorimotor retraining, oedema and pain control, psychosocial screening, and procedure-specific protocols that span joint-levelling osteotomy, vascularised bone grafting (including medial femoral trochlea flap), limited intercarpal arthrodeses, proximal row carpectomy, wrist denervation, and salvage arthrodesis or arthroplasty. Patient-reported, performance-based, and occupational outcome instruments are reviewed, with explicit declaration that no Kienb\u00f6ck-validated MCIDs exist. We also set out an integrative reference frame that cross-walks osseous, articular, and tissue-healing axes, offered as clinical orientation rather than as a validated algorithm. The most pressing evidence gaps (Kienb\u00f6ck-specific functional movement screens, sustained return-to-work data, and procedure-specific rehabilitation cohorts) are translated into four registered, powered, COMET-aligned trial proposals.<\/jats:p>","DOI":"10.3390\/jcm15145590","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T03:12:38Z","timestamp":1784257958000},"page":"5590","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Rehabilitation in Kienb\u00f6ck Disease: A Narrative Review of Current Concepts"],"prefix":"10.3390","volume":"15","author":[{"given":"Dimitar","family":"Tenev","sequence":"first","affiliation":[{"name":"Specialized University Hospital for Active Treatment in Orthopaedics \u201cProf. Boycho Boychev\u201d, Medical University of Sofia, 1614 Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedikt","family":"Hochbein","sequence":"additional","affiliation":[{"name":"Centre for Musculoskeletal Surgery, Charit\u00e9\u2013Universit\u00e4tsmedizin Berlin, 10117 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgi","family":"Enev","sequence":"additional","affiliation":[{"name":"Department of Consultation Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, 8091 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolay","family":"Cherkezov","sequence":"additional","affiliation":[{"name":"Specialized University Hospital for Active Treatment in Orthopaedics \u201cProf. Boycho Boychev\u201d, Medical University of Sofia, 1614 Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-0385-3940","authenticated-orcid":false,"given":"Jakob","family":"Adolf","sequence":"additional","affiliation":[{"name":"Specialized University Hospital for Active Treatment in Orthopaedics \u201cProf. Boycho Boychev\u201d, Medical University of Sofia, 1614 Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolay","family":"Dimitrov","sequence":"additional","affiliation":[{"name":"Specialized University Hospital for Active Treatment in Orthopaedics \u201cProf. Boycho Boychev\u201d, Medical University of Sofia, 1614 Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,16]]},"reference":[{"key":"ref_1","first-page":"77","article-title":"\u00dcber traumatische Malazie des Mondbeins und ihre Folgezust\u00e4nde: Entartungsformen und Kompressionsfrakturen","volume":"16","year":"1910","journal-title":"Fortschritte Geb. 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